The burden of disease and injury in Serbia.

BACKGROUND In the last decade of the 20th century, a considerable effort has been put into the development of summary measures of population health that combine information on mortality and non-fatal health outcomes. We used the DALYs (Disability adjusted life years) method to assess the burden of disease and injury in the population of Serbia. METHODS Our study, largely based on the methods developed for the Global burden of disease study, was conducted between October 2002 and September 2003. DALYs, stratified by gender and age, were calculated for 18 selected health conditions for the population of Serbia, Serbia and Montenegro for 2000. Years of life lost (YLL) were calculated using country mortality statistics, while years lived with disability (YLD) were calculated using different sources of information. Also, the YLD/YYL ratio and age-adjusted rates of DALYs were calculated. RESULTS Ischaemic heart disease, cerebrovascular diseases, lung cancer, unipolar depressive disorders, and diabetes mellitus were responsible for almost two-thirds (70%) of the total burden of 18 selected disorders in Serbia 2000. The leading five causes for males were ischaemic heart disease (26.1 DALY per 1000), stroke (17.9), lung cancer (12.7), road traffic accidents (6.5), and self-inflicted injuries (5.5). For females, the leading five causes were stroke (18.1 DALY per 1000), ischaemic heart disease (14.1), depression (8.7), breast cancer (6.1), and diabetes mellitus (5.2). CONCLUSIONS The final results of the study have shown that the national health priority areas should cover cardiovascular diseases, cancers, and mental health.

[1]  J. L. Bobadilla Searching for Essential Health Services in Low-and Middle-Income Countries , 1998 .

[2]  Ansley J. Coale,et al.  Regional Model Life Tables and Stable Populations , 1967 .

[3]  D. Cutler,et al.  Measuring the Health of the U.S. Population , 1997 .

[4]  Coronary heart disease incidence in diabetic patients, and its relationship to general risk factors , 1995, European Journal of Epidemiology.

[5]  Michael P. Todaro,et al.  World Development Report 1990. , 1990 .

[6]  R. Beaglehole,et al.  Alcohol consumption and risk of coronary heart disease. , 1991, BMJ.

[7]  M. Ilic,et al.  Case-control study of risk factors for prostate cancer. , 1996, British Journal of Cancer.

[8]  W. Kannel,et al.  Framingham study insights into hypertensive risk of cardiovascular disease. , 1995, Hypertension research : official journal of the Japanese Society of Hypertension.

[9]  D B Evans,et al.  Comparative efficiency of national health systems: cross national econometric analysis , 2001, BMJ : British Medical Journal.

[10]  T. Vos,et al.  Burden of disease and injury in Aboriginal and non‐Aboriginal populations in the Northern Territory , 2004, The Medical journal of Australia.

[11]  Alan D. Lopez,et al.  Summary Measures of Population Health: Concepts, Ethics, Measurement and Applications , 2002 .

[12]  M. Wolfson,et al.  Health-adjusted life expectancy. , 1996, Health reports.

[13]  J. Marinković,et al.  Burden of cancer in Serbia. , 2006, Croatian medical journal.

[14]  D. Jamison Investing in Health , 2006 .

[15]  J. Salonen,et al.  The community-based strategy to prevent coronary heart disease: conclusions from the ten years of the North Karelia project. , 1985, Annual review of public health.

[16]  C. Murray,et al.  A critical examination of summary measures of population health. , 2000, Bulletin of the World Health Organization.

[17]  M. Essink‐bot,et al.  Cross-national comparability of burden of disease estimates: the European Disability Weights Project. , 2002, Bulletin of the World Health Organization.

[18]  A. Coale,et al.  Revised regional model life tables at very low levels of mortality. , 1989, Population index.

[19]  J. Marinković,et al.  Infectious diseases mortality in central Serbia. , 1997, Journal of epidemiology and community health.

[20]  Alan D. Lopez,et al.  Quantifying disability: data, methods and results. , 1994, Bulletin of the World Health Organization.

[21]  Evidence and information for health policy: a decade of change , 2003, The Medical journal of Australia.

[22]  Debbie Bradshaw,et al.  Cause of death profile South Africa, 1996 , 2002 .

[23]  Alan D. Lopez,et al.  Global and regional estimates of cancer mortality and incidence by site: II. results for the global burden of disease 2000 , 2002, BMC Cancer.

[24]  J. Kurinczuk,et al.  The quantification of drug caused morbidity and mortality in Australia 1995 , 1995 .

[25]  G A Colditz,et al.  A meta-analysis of physical activity in the prevention of coronary heart disease. , 1990, American journal of epidemiology.

[26]  U. Laaser,et al.  The burden of disease and injury in Serbia , 2007 .

[27]  F. Hamers,et al.  HIV in central and eastern Europe , 2003, The Lancet.

[28]  J B Brunet,et al.  [AIDS surveillance in Europe]. , 1986, Revue d'epidemiologie et de sante publique.

[29]  C. L. Chiang,et al.  The life table and its applications , 1983 .

[30]  Alan D. Lopez,et al.  Mortality by cause for eight regions of the world: Global Burden of Disease Study , 1997, The Lancet.

[31]  H. Vlajinac,et al.  Risk factors for laryngeal cancer , 1995, European Journal of Epidemiology.

[32]  L. Gilson,et al.  International perspectives on health inequalities and policy , 2001, BMJ : British Medical Journal.

[33]  Patrick Blattner,et al.  Microsoft Excel 2002 , 2003 .

[34]  Alan D. Lopez,et al.  Regional patterns of disability-free life expectancy and disability-adjusted life expectancy: Global Burden of Disease Study , 1997, The Lancet.

[35]  Peter E. Hilsenrath,et al.  The World Health Report 2000 , 2002 .

[36]  J. Marinković,et al.  Years of life lost due to premature death in Serbia (excluding Kosovo and Metohia). , 2008, Public health.

[37]  Alan D. Lopez,et al.  Global health statistics: a compendium of incidence prevalence and mortality estimates for over 200 conditions. , 1996 .

[38]  A. Hyder,et al.  Applying burden of disease methods in developing countries: a case study from Pakistan. , 2000, American journal of public health.

[39]  M. Kraft,et al.  Epidemiology of asthma. , 2006, Clinics in chest medicine.

[40]  P. Erickson,et al.  Years of healthy life. , 1995, Healthy People 2000 statistical notes.

[41]  Marilyn J. Field,et al.  Summarizing Population Health: Directions for the Development and Application of Population Metrics , 1998 .

[42]  C. Mathers,et al.  The Australian Burden of Disease Study: measuring the loss of health from diseases, injuries and risk factors , 2000, The Medical journal of Australia.

[43]  B S SANDERS,et al.  MEASURING COMMUNITY HEALTH LEVELS. , 1964, American journal of public health and the nation's health.

[44]  Julio Frenk,et al.  World Health Report 2000: a step towards evidence-based health policy , 2001, The Lancet.

[45]  Shekhar Saxena,et al.  Multiple-informant ranking of the disabling effects of different health conditions in 14 countries , 1999, The Lancet.

[46]  J. W. Bush,et al.  A Health-Status Index and its Application to Health-Services Outcomes , 1970, Oper. Res..

[47]  Antihypertensive treatment in Germany, subjected to a cost-effectiveness analysis. , 1990, Journal of human hypertension.

[48]  M. Ilic,et al.  Diet and prostate cancer: a case-control study. , 1997, European journal of cancer.

[49]  W. Willett,et al.  A prospective study of nutritional factors and hypertension among US women. , 1989, Circulation.

[50]  Alan D. Lopez,et al.  Healthy life expectancy in 191 countries, 1999 , 2001, The Lancet.

[51]  S. Anand,et al.  Disability-adjusted life years: a critical review. , 1997, Journal of health economics.

[52]  M. T. Paixão,et al.  Expanded European AIDS case definition , 1993, The Lancet.

[53]  McGinnis Jm,et al.  Actual causes of death in the United States. , 1993 .

[54]  L. Garfinkel,et al.  Alcohol Drinking and Mortality among Men Enrolled in an American Cancer Society Prospective Study , 1990, Epidemiology.

[55]  E. J. Thompson Regional Model Life Tables and Stable Populations , 1967 .

[56]  Dr Terry Coyne Glen Pang Geoffrey Marks Type 2 Diabetes Costs in Australia - The Potential Impact of Changes in Diet, Physical Activity and Levels of Obesity , 2004 .

[57]  Alan D. Lopez,et al.  The burden of disease and injury in Australia. , 2001, Bulletin of the World Health Organization.

[58]  A D Négrel,et al.  Global data on blindness. , 1995, Bulletin of the World Health Organization.

[59]  Jan J. Barendregt,et al.  Disability weights for diseases in the Netherlands , 1997 .

[60]  Alan D. Lopez,et al.  Evidence-Based Health Policy--Lessons from the Global Burden of Disease Study , 1996, Science.

[61]  J. Lépine,et al.  Epidemiology, burden, and disability in depression and anxiety. , 2001, The Journal of clinical psychiatry.

[62]  Dean T. Jamison,et al.  World development report 1993 : investing in health , 1993 .

[63]  Philip D. Harvey,et al.  Cost effectiveness analysis of improved blood pressure control in hypertensive patients with type 2 diabetes: UKPDS 40 , 1998, BMJ.

[64]  R. Peto,et al.  Emerging tobacco hazards in China , 1999, BMJ.

[65]  Graham A. Colditz,et al.  Body weight and mortality among women , 1995 .

[66]  L. Kinlen Mortality from smoking in developed countries 1950-2000 , 1996, British Journal of Cancer.

[67]  D. Hoyert,et al.  Annual summary of vital statistics: 2000. , 2001, Pediatrics.

[68]  Qaiser Mukhtar Global behavioral risk factor surveillance , 2005, Journal of Epidemiology and Community Health.

[69]  D. Schopper,et al.  Estimating the burden of disease in one Swiss canton: what do disability adjusted life years (DALY) tell us? , 2000, International journal of epidemiology.

[70]  W. Groot,et al.  The value of health , 2008, BMC health services research.

[71]  Julio Frenk,et al.  Burden of disease assessment and health system reform: Results of a study in Mexico , 1995 .

[72]  H. Vlajinac,et al.  Risk factors for thyroid cancer. , 1994, Neoplasma.

[73]  S. Macintyre Evidence based policy making , 2003, BMJ : British Medical Journal.

[74]  Christopher J L Murray,et al.  Assessing the burden of disease in the United States using disability-adjusted life years. , 2005, American journal of preventive medicine.

[75]  Alan D. Lopez,et al.  Miscoding and misclassification of ischaemic heart disease mortality , 2001 .

[76]  J. Robine,et al.  Health expectancy indicators. , 1999, Bulletin of the World Health Organization.

[77]  Majid Ezzati,et al.  Global Burden of Disease 2005: call for collaborators , 2007, The Lancet.

[78]  Alan D. Lopez,et al.  The global burden of disease: a comprehensive assessment of mortality and disability from diseases injuries and risk factors in 1990 and projected to 2020. , 1996 .

[79]  Rafael Lozano,et al.  AGE STANDARDIZATION OF RATES: A NEW WHO STANDARD , 2000 .

[80]  C. Murray,et al.  Burden of disease--implications for future research. , 2001, JAMA.

[81]  W. van Biesen,et al.  The pattern of referral of patients with end-stage renal disease to the nephrologist--a European survey. , 1999, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[82]  J. Marinković,et al.  Burden of ischaemic heart disease and cerebrovascular diseases in Serbia without Kosovo and Metohia, 2000 , 2006, European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology.

[83]  J. Marinkovic,et al.  Environmental factors, health-related habits, and serum selenium levels in cancer patients and healthy controls , 2007, Biological Trace Element Research.

[84]  T. Aragón,et al.  San Francisco Burden of Disease and Injury: Mortality Analysis, 1990—1995 , 1998 .

[85]  Ware J.E.Jr.,et al.  THE MOS 36- ITEM SHORT FORM HEALTH SURVEY (SF- 36) CONCEPTUAL FRAMEWORK AND ITEM SELECTION , 1992 .

[86]  A. Williams,et al.  Calculating the global burden of disease: time for a strategic reappraisal? , 1999, Health economics.

[87]  Richard Doll,et al.  Mortality in relation to smoking: 22 years' observations on female British doctors. , 1980, British medical journal.

[88]  Paul Bebbington,et al.  The World Health Report 2001 , 2001, Social Psychiatry and Psychiatric Epidemiology.

[89]  K Poikolainen,et al.  Alcohol and mortality: a review. , 1995, Journal of clinical epidemiology.

[90]  T. B. Üstün,et al.  Global burden of depressive disorders in the year 2000 , 2004, British Journal of Psychiatry.

[91]  Alan D. Lopez,et al.  The utility of DALYs for public health policy and research: a reply. , 1997, Bulletin of the World Health Organization.

[92]  Steffen Flessa,et al.  Investing in health , 2007, Journal of Public Health.

[93]  U. Laaser,et al.  Reduction of coronary heart disease risk factors in the German cardiovascular prevention study. , 1996, Preventive medicine.